Supplements offer little CV benefit, and some are linked to harm
Reporter: Aviva Lev-Ari, PhD, RN
JACC VOL. 69, NO. 9, 2017 Cardiovascular Nutrition Controversies MARCH 7, 2017:1172 – 8 7
https://pdfs.semanticscholar.org/55ce/5835f4ec4a5b5a02afe34a30bd90f05cc839.pdf
ADDRESS FOR CORRESPONDENCE: Dr. Andrew M. Freeman, Division of Cardiology, Department of Medicine, National Jewish Health, 1400 Jackson Street, J317, Denver, Colorado 80206. E-mail: andrew@docandrew.com.
TABLE 1 Clinical Recommendations for Specific Dietary Patterns, Foods, and Nutrients Nutrition/FoodItem Level of Evidence Available and Included in This Paper Recommendations for Patients Dietary pattern with added fats, fried food, eggs, organ and processed meats, and sugar-sweetened beverages (Southern diet pattern) Prospective studies Avoid Dietary cholesterol RCTs and prospective studies along with meta-analyses Limit Canola oil RCT meta-analyses show improvement in lipids but no prospective studies or RCTs for CVD outcomes In moderation Coconut oil RCT meta-analyses and observational studies on adverse lipid effects. No prospective studies or RCTs for CVD outcomes Avoid Sunflower oil No prospective studies or RCTs for CVD outcomes In moderation Olive oil RCTs supporting improved CVD outcomes In moderation Palm oil RCTs and observation studies showing worsened CVD outcomes Avoid Antioxidant-rich fruits and vegetables RCTs and observational studies showing improved CVD outcomes and improvements in blood lipids Frequent Antioxidant supplements RCTs and prospective and observational studies show potential harm Avoid Nuts RCT and large prospective and meta-analysis studies showing improved CVD outcomes In moderation Green leafy vegetables Large meta-analyses and variably sized observational studies as well as a large prospective study Frequent Protein from plant sources Large observational and prospective studies Frequent Gluten-containing foods Observational studies and RCTs Avoid if sensitive or allergicCENTRAL ILLUSTRATION Evidence for Cardiovascular Health Impact of Foods Reviewed Summary of heart-harmful and heart-healthy foods/diets Coconut oil and palm oil are high in saturated fatty acids and raise cholesterol Extra-virgin olive oil reduces some CVD outcomes when Blueberries and strawberries (>3 servings/week) induce protective antioxidants 30 g serving of nuts/day. Portion control is necessary to avoid weight gain.† Green leafy vegetables have significant cardioprotective properties when consumed daily Plant-based proteins are significantly more heart-healthy compared to animal proteins Eggs have a serum cholesterol-raising effect Juicing of fruits/vegetables with pulp removal increases Southern diets caloric concentration* (added fats and oils, fried foods, eggs, organ and processed meats, sugar-sweetened drinks) High-dose antioxidant supplements Juicing of fruits/vegetables without pulp removal* Gluten-containing foods (for people without gluten-related disease) Evidence of harm; limit or avoid Evidence of benefit; recommended Inconclusive evidence; for harm or benefit Sunflower oil and other liquid vegetable oils consumed in moderate quantities Freeman, A.M. et al. J Am Coll Cardiol. 2017;69(9):1172–87. This figure summarizes the foods discussed in this paper that should be consumed often, and others that should be avoided from a cardiovascular health perspective. *It is important to note that juicing becomes less of a benefit if calorie intake increases because of caloric concentration with pulp removal. †Moderate quantities are required to prevent caloric excess.
Takeaway
- Antioxidants and niacin are tied to increased all-cause mortality, and other popular supplements offer little detectable cardiovascular (CV) benefit.
- Folic acid and B6 and B12 might offer some stroke protection.
Why this matters
- Supplements, including multivitamins, vitamins C and D, and calcium, remain hugely popular.
- These authors evaluated supplement-related randomized controlled trials published before and since the US Preventive Services Task Force’s 2013 evidence review and 2014 recommendation statement.
Keyresults
- 4 most common supplements (vitamins D and C, calcium, multivitamins) had no effect on CV outcomes, all-cause mortality.
- With folic acid
- Modest stroke reduction (2 studies: relative risk [RR], 0.80; P=.003).
- CV disease reduction (5 studies: RR, 0.83; P=.002).
- Other supplements
- B-complex: reduced stroke risk, 9/12 trials (RR, 0.90; P=.04).
- Niacin: taken with statin, tied to 10% increased all-cause mortality (P=.05).
- Antioxidants: increased all-cause mortality, 21 trials (RR, 1.06; P=.05; without selenium: RR, 1.09 [95% CI, 1.04-1.13; P=.0002]).
- No effect of vitamins A, B6, E, beta-carotene, minerals.
Study design
- Meta-analysis, 179 randomized controlled trials (15 since 2013/2014).
- Outcomes: all-cause/CV mortality, total CV disease risk/related outcomes.
- Funding: Canada Research Chair Endorsement, others.
Limitations
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No long-term cohort studies included.
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Selected populations in clinical trials.
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Supplement differences possible.
Other related articles in this Open Access Online Scientific Journal include the following:
Nutrition: Articles of Note @PharmaceuticalIntelligence.com
Author and Curator: Larry H. Bernstein, MD, FCAP and Curator: Aviva Lev-Ari, PhD, RN
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